Pulm part 2 Flashcards
Step 1 asthma tx for 12 yrs or older
SABA PRN
Step 2 asthma tx for 12 yrs or older: preferred
Low-dose ICS
Step 2 asthma tx for 12 yrs or older: alternative
Cromolyn
LTRA
Nedocromil
or Theophylline
Step 3 asthma tx for 12 yrs or older: preferred
Low-dose ICS + LABA
OR
Medium-dose ICS
Step 3 asthma tx for 12 yrs or older: alternative
Low-dose ICS + either:
LTRA
Theophylline
or Zileuton
Step 4 asthma tx for 12 yrs or older: preferred
Medium-dose ICS +
LABA
Step 4 asthma tx for 12 yrs or older: alternative
Medium-dose ICS + either:
LTRA
Theophylline
or Zileuton
Step 5 asthma tx for 12 yrs or older
High-dose ICS +
LABA
AND consider omalizumab for pts who have allergies
Step 6 asthma tx for 12 yrs or older
High-dose ICS +
LABA +
oral corticosteroid
AND consider omalizumab for pts who have allergies
MC age for foreign body aspirations
Children younger than 3 yrs
Reasons children are more prone to foreign body aspirations
Lack of molar teeth that decreases their ability to sufficiently chew food
Propensity to talk, laugh, and run while chewing
Examination of even non-food substances in the mouth
Presentation of foreign body aspiration
Often, presents after sudden episode of coughing or choking while eating with subsequent wheezing, coughing, or stridor
When not witnessed, persistent or recurring cough, wheezing, persistent or recurrent PNA, lung abscess, focal bronchiectasis, or hemoptysis
PE of foreign body aspiration
New abnl airway sounds
Sounds are inspiratory if in the extrathoracic trachea.
Noises are more prominent in the central airways if in the intrathoracic trachea
Workup of foreign body aspiration
Radiography
Bronchoscopy
Heimlich maneuver only if child is unable to speak
Tx of foreign body aspiration
Endoscopic removal
Causes of hyaline membrane disease
Occurs after the onset of breathing and is associated with an insufficiency of pulmonary surfactant
RFs of hyaline membrane disease
Prematurity is the greatest risk Delivery of a previous preterm infant with hyaline membrane disease Maternal diabetes Hypothermia Fetal distress Asphyxia Male sex White race Being the second-born of twins Delivery by C-section without labor
Presentation of hyaline membrane dz
Cyanosis Tachypnea Nasal flaring Intercostal and sternal retractions Grunting
Tx of hyaline membrane disease
Antenatal administration of corticosteroids to the mother 48 hrs prior to labor
After birth, intratracheal administration of exogenous surfactant
Maintain pH above 7.25
Increased concentration of warm and humidified inspired oxygen
Nasal continuous positive airway pressure
Ventilator
Cause of cystic fibrosis
Autosomal recessive disorder
Mutation of the cystic fibrosis transmembrane regulator (CFTR)
Manifestations of cystic fibrosis initially in older children
Poorly controlled asthma and chronic respiratory infections Persistent or recurrent cough that is often productive of sputum Digital clubbing Chronic sinusitis Nasal polyposis Pneumothoraces Steatorrhea Deficiencies of fat-soluble vitamins Distal intestinal obstruction syndrome Insulin deficiency Hyponatremia and hypochloremic metabolic acidosis Reproductive dysfunction
Presentation of cystic fibrosis in infants
Meconium ileus Failure to thrive Cholestatic jaundice Chronic respiratory sx Electrolyte abnormalities
Dx of cystic fibrosis
DNA testing
Sweat chloride test
Tx of cystic fibrosis
Chest physiotherapy
Antibiotic therapy
Enteric-coated pancreatic enzyme capsules
High-calorie diets with the addition of nutritional supplements
Insulin for CF-related diabetes
Multifactorial
